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Intro to D&D Midterm > Geriatrics > Flashcards

Geriatrics Flashcards

1
Q

elderly patients are referred to greater than or equal to what age?

how can this be subdivided?

A

elderly = greater than or equal to 65

young-old (65-74)
old-old (75-84)
very old-old (85+)

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2
Q

by 2030, 1 in _____ US residents is expected to be greater than 65

A

1 in 5

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3
Q

what is the most rapidly growing age group in America?

A

adults 85 and older

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4
Q

true or false

the number of persons age 65 and older is expected to decline in coming years

A

FALSE - increase

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5
Q

what are the 5 “m’s” to remember for geriatric patients

A

Mobility
Mentation
Medication
What Matters
Multi-Complexity

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6
Q

what is the most important healthcare technology in preventing illness, disability, and death in the geriatric population?

A

medication

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7
Q

any symptom in an elderly patient should be considered what?

A

a drug side effect

(until proven otherwise)

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8
Q

true or false

it is possible for hospital admissions to be drug related

A

true

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9
Q

true or false

older adults are not at higher risk for adverse drug reactions as compared to young adults

A

FALSE - they’re 2-3 times at risk of an ADR

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10
Q

true or false

adverse reactions are more likely in older adults, but the outcomes are not significant as compared to younger adults

A

FALSE

the outcomes ARE more significant in older adults

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11
Q

true or false

medication related events is bad financially

A

true - costs around 528 billion a year and most occurs in older adults

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12
Q

what is the problem to consider when comparing the expected medication effects between a young adult and an older adult?

A

the dose of a given medication produces a different and sometimes unexpected response in an older patient

even if the same gender and similar body weight

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13
Q

true or false

if the gender and weight of a young person and old person are the same, their medication outcomes with the same dose of a drug given will likely be the same

A

FALSE

geriatric patients have a different and sometimes unexpected response

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14
Q

what is the “explanation” to the problem that geriatric patients produces a different and sometimes unexpected response to the SAME DOSE of a medication as a younger person?

A

there are pharmacokinetic and/or pharmacodynamic alterations with age

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15
Q

which explains the effect that a body has on a drug - pharmacokinetics or pharmacodynamics?

explain

A

pharmacokinetics

ADME

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16
Q

what does pharmacodynamic mean

A

the effect that the drug produces in the body, usually through binding to receptors

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17
Q

name 3 different types of absorption

A

gastrointestinal absorption
intramuscular absorption
transdermal (topical) absorption

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18
Q

the effect of drug-protein binding changes with age.

this is under which category of pharmacokinetics?

A

distribution

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19
Q

*which “piece” of pharmacokinetics is LEAST affected by aging

A

GI ABSORPTION

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20
Q

explain why GI absorption is the least part of pharmacokinetics that is affected by aging

A

due to decreased gastric emptying, there may be a delayed onset of action. However, this is really only clinically significant for acute drugs such as tylenol

chronic drugs are not really affected by this

therefore, there is not a significant change in the QUANTITY of drug absorbed, there just may be a delay in the drugs peak time or onset time

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21
Q

true or false

geriatric patients have increased GI motility

A

false - decreased GI motility, leading to prolonged absorption

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22
Q

true or false

geriatrics have decreased gastric emptying rate

A

true - this is what can delay the onset/peak time of acute drugs

23
Q

true or false

geriatrics have increased intestinal blood flow

A

false - decreased

24
Q

true or false

geriatrics have decreased intestinal surface area

A

true

25
Q

**in geriatrics, as mentioned, GI absorption seems to be the least affected by aging.

which component of changes in GI absorption due to age is the MOST important? why?

A

decreased gastric acid output because we design drugs to dissolve in this acid. if there’s not enough of it, the absorption of the drug may not be good

26
Q

name a drug that doesnt need an acidic environment to absorb

A

calcium citrate

27
Q

true or false

elderly patients have decreased gastric pH

A

FALSE - increased

28
Q

explain how IM absorption is affected by aging

A

possible decreased IM absorption because there is:

-decreased muscle mass (hard to find spot)
-decreased peripheral circulation (is the drug getting into blood)
-increased connective tissue (is drug getting into blood?)

29
Q

explain how topical (transdermal) absorption changes with age

A

there is a concern with both the drug penetrating the skin and also if the drug does penetrate, is it even getting into the bloodstream

concern with no penetration due to decreased skin hydration and surface lipids, as well as increased keratinization

concern with getting into blood due to decreased peripheral circulation

thus, there is possible decreased absorption from transdermal patches with age

30
Q

true or false

geriatrics have increased surface lipids

A

false - decreased

thus, penetration and thus absorption from transdermal patches may be affected

31
Q

true or false

elderly patients have increased keratinization of the skin

A

true - penetration of skin through transdermal patches is a concern

32
Q

explain how distribution changes with age

A

mostly a concern for lipid soluble drugs

elderly have increased body fat. thus, lipid soluble meds will be distributed to the fatty tissues. high Vd

33
Q

true or false

age-related changes in drug distribution are not really a concern for water soluble meds

A

true

34
Q

true or false

with age, there is a low Vd of water soluble medications

A

true

high Vd for lipid soluble medications due to increased fat. this is a problem in relation to the distribution portion of ADME

35
Q

elderly patients have ______ cardiac output

how is this a concern?

A

decreased cardiac output

this is a concern with the distribution of the drug.

if a drug is being administered to relieve pain in the toes, there is a concern over whether the drug will even be DISTRIBUTED there due to decreased cardiac output compared to a young and healthy person

36
Q

true or false

elderly patients have increased body water

A

false - decreased

37
Q

how does protein binding change with age and why is this a concern

A

there is DECREASED serum albumin

this means that drugs that are highly protein bound like phenytoin and warfarin, will have an INCREASED free fraction in the bloodstream (because not bound to albumin) and thus more easily toxic

38
Q

true or false

geriatrics have decreased protein affinity

A

true

39
Q

true or false

geriatrics have increased alpha1-acid glycoprotein

A

true

40
Q

name 2 highly protein bound medications

A

phenytoin
warfarin

41
Q

both metabolism and elimination of drugs are affected by age.

which is more significant?

A

renal elimination

42
Q

explain how drug metabolism is affected by age

A

there is decreased hepatic mass and bloodflow

phase 1 reactions (oxidation/reduction/hydrolysis) are DECREASED

phase 2 (conjugation) is UNCHANGED as well as CYP450 activity

enzyme induction/inhibition is controversial

43
Q

true or false

drugs that are metabolized via phase 1 enzymes are preferred for geriatric patients

A

FALSE

phase 1 metabolism activity is DECREASED with age

drugs metabolized via phase 2 are preferred

44
Q

true or false

CYP450 activity is unchanged in elderly populations

A

true

45
Q

true or false

geriatrics have both decreased renal blood flow and decreased renal tubular secretion

A

TRUE

46
Q

true or false

geriatrics have increased GFR and thus decreased creatinine clearance

A

FALSE

decreased GFR and thus decreased creatinine clearance

47
Q

explain how estimating renal function may be more difficult in elderly patients

A

creatinine is made by muscle.

elderly have decreased muscle mass and thus are making much less creatinine than a young person

thus, it can be easy to look at blood levels and see low creatinine and think renal function is fine, but must remember that they are making much less to begin with

48
Q

true or false

elderly may have stable serum creatinine, even if kidney function is poor

A

true - due to increased muscle mass and thus making less creatinine to begin with

49
Q

the average renal function of an 80 year old is ~____% of a 20 year ofd?

A

around 50%

50
Q

older drugs used creatinine clearance as a measure to determine renal dosing

newer drugs use what?

A

eGFR (estimated glomerular filtration rate)

51
Q

what equation is used to estimate creatinine clearance?

A

Cockcroft-Gault equation

52
Q

memorize formula?

A

memorize formula?

53
Q
A

Intro to D&D Midterm (29 decks)

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